Feline Urinary Troubles: Understanding FLUTD and Its Management

Music.

Really, the goal is just to use our stories to bring veterinary medicine to life for the pet caretakers of the world. And we're doing it because we believe that educating these caretakers is the most powerful thing that we can do to improve the life quality of all of the pets that we love. Hi, everybody. Welcome back. Hello. Yeah, Vet Tales. I'm Dr. Natalie Key. Dr. Josiah Dane. Here we go. All right. Cat stuff. Cat stuff. They don't get, like, talked about enough.

No, they don't. They get lumped in. They get lumped in, but this today is a cat-specific problem. Yes. And while you are talking about... Urine. Fluted. Fluted. I was like, can I title this episode Cat, period. Urine trouble. Fluted. What does fluted mean? Femalelower urinary tract disease. Okay. Yeah. Did I pass? Well, I just didn't really. I never used Flute. Oh, really? Okay, yeah. Yeah, it's like this encompassing. I knew what it meant. He does. Don't be worried.

He definitely knows what it means. But it's like some people say it, some people don't. But it's designed to encompass a myriad of urinary issues that cats get, and specifically chronic recurrent versions of that. And the reason why we lumped them together is because they all typically present the exact same. They do. Yeah, it's super frustrating because of that very thing. You're like, I don't know, are you, do you have a horrible cystitis or you have

an obstruction? Either way, only tiny drops of bloody pee come out. Yes, exactly. One is like annoying and one is life-threatening. No other differences. So sorry, we have to do diagnostics. We definitely do. Yes, this is not a guess and check. Yes. So typical, like presenting clinical signs or symptoms that we see with fluted are going to be bloody urine, straining to urinate, and that could be a lot of urine coming out or no urine coming out.

Urinating in unusual places, everyone's favorite. Yes. Urinary blockage, which is almost exclusively a male cat issue. Yeah. And then licking of that area. Yeah, yeah. Excessive grooming and stuff. Yeah. And they can block. Like, yes, stones can cause them to block. But I've seen block cats just from inflammation. Yeah, because they'll get vibrant and blood clots and things and block with bats. I see.

It really is. Yes. Yeah. And the blockages are the scariest thing because those are life-threatening within a relatively short period of time. Extremely. And they're just stressful. And quite frankly, it's expensive to treat as well because it's going to require hospitalization, catheters on the way in, catheters on the way out. Like we're a check. Yes. Up and down multiple times. Making sure the kidneys are in the electrolytes. Yeah, yeah.

So, great. A segue into how do we diagnose it? Well, first we need... What we're diagnosing. Yeah, yeah. How do we figure out what the issue is? Right. So owner notices some cat in the house is peeing somewhere that they're not supposed to, and they noticed it was pink. They don't know which cat it was. They don't. They never know which cat it was. They set up a ring door camera, which is my favorite. I love when people do that. I do too. It's like, oh, thank God, evidence.

But usually they have a sneaky suspicion which cat it is. Or sometimes a cat would be vocalizing when they urinate, and that's a good tip off because it hurts. And so they'll bring the cat in. And the very first thing that we do is put an ultrasound probe over the top of the bladder and try to obtain a urine sample.

Yes. And so that's like two for one because we're looking at the bladder itself, looking how big it is, looking at the contents within the bladder, looking for, and then where we hold the urine, looking at the urine itself visually, just grossly. And then we put it into our urinalysis machine and we look at lots of data. Yeah. Of the urine. Yeah. Like your first thing, when you put that ultrasound probe on, you're like, oh, thank God it's not blocked.

Yeah. And then, or if it is blocked, you're like, well, here we go. And then we go, is there cancer? Yeah, yeah. There's always been a mixed thought. Yes. Depending on the cat, you know, like dogs, that's my very, very first thought. But on cats, I'm like, how many stones? Where are they? Where are they at? Yeah. Crystals. Yeah. But hopefully you don't find that. And sometimes what we'll actually find instead is a completely empty bladder.

Ladder and then we will ask you to leave your cat with us for a few hours while it makes more pee and then we try again yep and then hopefully they don't be on their blanket and they're getting well so now we have like that hydrophobic sand yeah which is nice because it doesn't like beads the urine up quite nicely on top and the cats don't mind the substrate because it feels familiar to them but you get a lot of debris it isn't like the old

lab litter with the little They were stressed out about that. They didn't, the cast didn't love it, but it made a better urine sample. So anyway, most of the time they're producing urine within an hour. We can snag it. Yeah. Yeah. And then the really tough ones are when they're super inflamed and they're like just being super small amounts, but constantly, and then you're like, sometimes you have to just like treat them, which we don't like to do.

But if we literally cannot obtain a sample, we can't do it. And the reason why we want urine is because we want to make sure if there is a UTI or if this is what we call sterile cystitis or just sterile inflammation of the bladder, which is really common in cats and doesn't require an antibiotic, but rather just requires anti-inflammatories to calm the bladder down and then looking for the source of what triggered the inflammation, which is the hardest part.

That is the hardest part. Because we may never know. Yeah. Because stress alone can cause that to have a inflamed bladder. Yeah. Yeah. So we'll get into like a whole bunch of options for that. Yeah. When we get to treatment. So, you know, but many times we are finding like an underlying cause. So like crystal urea, crystals in the urine, a bladder infection proper. In those cases, you're like slam dunk. Thank goodness. I know what we're doing. Nobody has to stay in the hospital.

Have fun stacks oh yeah let's hear the stats for cats who are around the age of four if they're presenting with flutin 50 will not have a cause that can be determined despite extensive testing well that's not fun which would be the idiopathic cystitis or fic if you're in commercial cystitis where we don't know why they have it it's sterile it's just there yeah 20 will have stones 20 will will have a urethral blockage, but 1% to 5% will have an actual UTI.

Whoa. 1% to 5% will have a urinary tract cancer. 1% to 5% will have trauma. Wait a minute. So they just put the same percentage on UTIs as they did carcinoma? Yeah. Listen, I've seen a jillion UTIs and I've seen two cat bladder cancers. Well, they change. The numbers change when you get to the age of 10. Oh, okay. So this is a four-year-old. One to five percent will be a combination of bladder stone and infection. Yeah. Okay. Then when you get to the age of five, 50 percent have UTIs. Oh.

10 percent will have bladder stone. Second team will have a combination infection bladder stone, which is UTIs. 7% will have a urethral blockage. 3% will have urinary cancer, urinary tract cancer. 5% will have a cause that cannot be determined. So FIC or idiopathic cystitis. 66% will have some kind of insufficient kidney function, which matters.

5% will have urinary incontinence. The reason why 66% having insufficiency, kidney insufficiency matters is because when you have diluted urine. Diluted? Diluted.

More than a new urine you're going to have higher incidence of infection because the point of having concentrated urine is to basically constantly flush out your urinary tract and when you're basically peeing something closer to water the bacteria is like we and swims right up yeah yeah it creates problems yeah i thought that was interesting this is from Then Veterinary Partners, which is a huge listserv website for veterinarians. And this is a handout from the handout for clients.

Oh, nice. Okay, cool. Citing your stats there. Nicely done. We are so professional on those. Thought that was super cool. It is super cool. I mean, I'm fascinated about the breakdown on the actual UTIs from a cat, four and under versus five and above. It's really interesting. seeing. Yeah. Which the most common cat to come in blocked is going to be a male. And I feel like two, five is usually when they're like really blocking. Yeah. Yeah. So just like a tiny tangent on blocked toms.

They're usually not toms. They're usually neutered males. We call them blocked toms. What is the word for a neutered male? Something with a G. Yeah. Anyway, they basically, if they're neutered too young, then they are at an increased risk of getting urinary obstructions later, which is why as veterinary professionals in a client-based work environment, not a shelter, we are organizing our thought process around your specific cat. And so our specific goal is to keep your specific cat healthy.

And so we recommend not neutering any time before six months. Yes. But in shelters, like that just isn't always the thing. It's just what happens. Yeah. Yeah. So hold on. Why can't I not find this? Licking up what your cat is called. I know. I really think it's like, I don't want to guess because then I'm going to be wrong, but I have a name in my head. We'll see if I was right. Oh, no, I was wrong. But yeah, it's called a GIB, G-I-B. I knew it was a G. Let's see.

I want to know. Hold on, I got to look up what the word actually means. Anyway, so. I was going to say a GOMER, which is an inept or stupid colleague, which feels a little bit like me right now, especially a trainee. Anyway, okay, GIB, GIB it is. So, the breakdown brought us some differentials. Yes. We typically come to the diagnosis through ultrasound, urinalysis. Yep. Sometimes culture and sensitivity. But we're supposed to do this way more often than we do.

But the practicality, the turnaround time can be cumbersome. Typically, the process we follow is urinalysis, ultrasound, treat, recheck the UA in seven days. If bacteria is still noted, we normally would recommend. Before moving to a finger kind of antibiotic. Yeah, it's nice because the IDEX machine will actually do bacterial presence confirmation testing and it doesn't cost any extra. So sometimes the urinalysis machine will be like, suspect, we suspect there's bacteria.

And then there's like this separate, kind of within the same system, you add these different adjuvants and we get this different test results and it will confirm or rule out the presence of bacteria in there.

So that's kind of another way we avoid having to do as many cultures yeah and so that's kind of what we do for utis most of the time 99 of the time they resolve with just the first defense antibiotic which is a cephalosporin of some sort and they respond very well and they do great and then you know for stones and crystal urea so crystal urea just means there's crystals in the urine, which are forming typically due to the environment and the pH of the urine,

which is like how acidic or basic it is, those patients don't always have stones and stone patients don't always have crystal urea, so they're kind of separate, but then you can also get storm stone formation, which is most of the time, definitely male cats are going to be surgical. You can start, you know, a specialized diet and see if they'll dissolve, but. Yeah, stouts are not great on the dissolving of the stones.

But I always like, especially if I really don't want this cat to have to go to surgery and it's pretty stable otherwise. And females, we're more likely to try it with a female because I'm not as worried about them getting a light-threatening blockage. Yeah, I'm more worried about males. I'm like, no, I'm not worth it. I'm not going to risk it. Yeah, but I'll give them a couple of weeks on the food and recheck the stone diameter on an x-ray and see if you're making any progress. breasts.

That's if they aren't actively clinical and like struggling. And so like not every patient is a candidate to do the diet dissolving, you know, try to do that for surgery. I've had a couple and I've gotten maybe a handful to actually dissolve with just the food alone. And there's just a lot of factors that go into that. But you're like, we have to monitor them so closely because you don't want them

to block while the stonus is all being filled. And the anxiety that The owners are having to deal with whenever they're straining to urinate. They're like, are they blocked or just in blame? Are they blocked or just in blame? Another thing you think is easier to pickle. Yeah, just so stressful. So the food still is imperative regardless. That's right. Yeah. Long-term management of crystal urea, cats with stones, cats who have blocked before.

That's probably the most important discussion on all of this. It is. I mean, yeah. What do we do? We put them on a urinary diet. There are multiple brands available. And things, but I'm going to name drop my favorite. What? Only ever used Royal Canin. Yeah. So I, when I was first out of school and in school, we used Hill Science Diet CD. And it's pretty effective. But the reason I like the Royal Canin, there's two reasons.

One, I think the cats like it better. I love it. They do. My cats love it. Yeah, they really do. It's like the most palatable diet, in my opinion, whatever that is word. And then the other thing is that they have the urinary comb. Comb because a lot of this is stress induced and the comb has like DHAs in it, which is designed to like be more soothing, to decrease stress level within the cat. And then the other big thing that this food is doing is that it's changing the pH of the urine.

So the stones and crystals are less likely to survive and the bladder wall is just happier. So a lot of times when I have this conversation with dog or cat owners, honestly, I'll be like, we need to change the food. And they're like, but they're on a really good food. And I'm like, no, I definitely agree. There's nothing wrong with the food you're feeding your animal. However, this food is like a medicine that prevents the problem you're having.

It's dissolving or changing the pH to make the bladder a healthier environment where UTIs and crystals and stones are less likely to be present. It also helps them drink more. It dilutes their, the goal of it too, is to dilute their urine. Yes. So they'll drink and pee more and flush out all the little icky stuff with. Yeah. We love it. And it really stinks when you have, like, this is a tale from Dallas, not from here. But I had a client who I removed stones on, like, my first year of practice.

And I was like, okay, continue your ASO. And then I saw them a year later. They didn't continue the diet. And that poor dog had so many stones again. And we removed them again. And I was like, the cost of the surgery is more than the bag of food once a month. Oh, I mean, by heart. If I was like, if we would have stayed on the food, you would have paid less. It wouldn't have been all money. They have to eat anyway. They do. So, I mean, the prescription diets are obviously more expensive than

a non-prescription diet, but it will save you, I mean, over and over again. Yeah. You know, especially when you subtract out. So, if this bag is going to be $40 and your normal cat food is $20, you're really only spending $20. Yeah. Not $40. Yeah. If that makes sense. And then when you get to the nitty-gritty, the surgery bills and potential hospitalization are just so expensive. Yeah, especially if they block. It was in doubt, so it was even worse. Yeah, you're right. Yeah.

Also, get pet insurance. Cat pet insurance is like 14 bucks a month, y'all. Get on board. Yeah. But yeah, I was like, no, you get about two years of food for once for tricking. Right? Yeah, I was like a 40-pound dog, too. So it's the anesthesia was more expensive. Yeah. And then it's, you know, there's more scarring and blah, blah, blah. All the risks, especially when you go back to cats, like the risk is so high of obstruction. And that's like writing again.

So anyway, but even if they don't have stones or crystals and they just have sterile cystitis repetitively or UTIs repetitively, we still insist on these diets because it's a game changer. And you can do other like de-stressing things. Too. So we walk through all sorts of environmental changes. Environmental changes, pheromone diffusers, so feel-away is going to be the big one.

And then sometimes if they are really a stressed cat, or there's something in the environment that we can't change, then sometimes we reach for like daily gabapentin or fluoxetine. Yeah.

Yeah. I like the feel-away a lot. You can get it anywhere it's like f-e-l-i-w-a-y but it is a positive pheromone so like as i understand it it's you know when cats are happy and they like wipe their cheek and all that drool comes out it's like there's all these smelly goods in there for cats and they're basically recreating that which says this is a safe happy place i am i belong here and you can put them as room diffusers it's spray they wipe so like you can wipe down their

kennel or whatever and i do find a lot of, With just the food alone, like the urinating call and the feel-away, I've been able to manage most of my. Yeah, or even if you cut down their episodes by 80%, it's worth it. You can definitely get a good handle on it without having to do the daily medication, which is the goal. Yeah, it really is the goal. Because one, nobody wants to give them medicine that their animal doesn't strictly have to have.

And two, absolutely no one wants to medicate their cat daily. No. Nobody. Nobody ever was like, can I medicate my cat daily? And I don't know what you do, but I normally start with gabapentin. I try to look at trial and gabapentin. I mean, yeah.

For a good while and I will then move to. Yeah. And I think the nice thing about gabapentin is it's like a twofer because it's also going to help with like winds up pain, which they do believe is a large part of what cystitis, how it becomes kind of perpetuating within the system is because then the pain is causing more stress, which is causing more pain and more stress. And so the cystitis just, you know, keeps happening.

Yeah. So you've got like that double like benefit of it is a bit of a downer for them. Like, so they're not as anxious, but it also is helping with chronic pain. Yeah. Exactly. And then Crozac sometimes we end up on, but I have very, not very commonly. I don't like to point out. I think people think that cats get put on it more often, but they. I can only think of like two cats I've ever put on it. I've put one cat on it in five years.

And yeah. And I'm on like year 15. so like and i think it's hard if i'm being honest guys i think it was already on it.

I think i just like sure continuing yeah yeah that looks great if it's not broke don't fix it, oh so it's not as common as i think it seems but more commonly diet change fair fear away and gabapentin yeah i feel like it's where the road usually stops yeah and then a lot of it too is just like fat home management so like i will tell owners your boxes lots of litter boxes so you need one more litter box then you have cats and if you have seven cats i'm just really sorry that applies to

you too listen i have two and i'm gonna you only have one okay well and so i should have more but i am lucky and my boy cats just don't care right that's the thing is like if you're getting by like that's fine but if you're having a problem because cats are silent bully years. Yeah, they really are. My cats aren't silent about it. My cats are like... They're like junior high girls. They tackle each other, my cats. Your cats tackle each other. I love it. They do WWE moves.

One of my cats who's fat goes up to the skinnier one, wraps his arms around his neck, throws him onto the ground. That's awesome. We need video of that. How old are they? Four and three. Oh, yeah. So that's perfect. Yeah. They're constantly throwing down.

Down and then sometimes it'll get spicy and go for my 10 year old dachshund and he goes like he screams no because they do the lion thing where they like jump on his back kind like a lion on a zebra poor dog oh god help him anyway so yeah so if you're getting by with it that's fine but if you're not getting by with it that's a very important stuff like stuff yes and then also So, like, you know, sometimes people have to, like, have, like, the bedroom cat.

And they. Right now, who the bully is. Yeah. Which is hard. The patio cat. The bully doesn't look like the bully. Yeah. And it even gets in the weeds for me where I'm like, I don't know. Like, it's like watching an episode of Big Brother. Yeah. Like, I don't know who's being the aggressor here. Somebody's. I'm just like, you can't have ring cameras all over your home. Yeah. But there are, we do have actually specialist services for behavior at OSU. And so that is an option.

And I know that I've been doing a couple of her talks now. What's her name? I could not tell you. She's at Oklahoma State and she's done a few talks with the CE that I've been to. Interesting. So that's an option if it gets like out of hand where we can't control it to hear for referral. And then...

I'm trying yeah the other thing is if we continue just kind of like last kind of treatment option for cats who are either blocking a lot or have blocked a lot block again this is like the third time you've blocked some hatchery recommend surgery not super commonly because most cats don't get to that point but there's a surgery called pu then it's where they remove because because typically male cats are going to be the ones blocking,

they will remove the penile tissue and leave them with an artificial larger opening. We normally refer out. This is one of the few surgeries we refer out for. I feel like we normally refer out for that surgery. It's quite involved, but they do very well. We just haven't recently get it done. He had blocked like four times, I think, and then they went and got the PU done,

and she was like, he is completely normal around. and having a very normal happy life again because he had a whole lot of structural issues down there. And so he was kind of like perpetually blocked. Is it Letitia Fenucci? Yes. Okay, yeah. Yes. Cool. There you go. There's the answer. It's F-A-N-U-C-C-H-I. And you can actually go to OSU's website and just like make your own appointment if you want to. And she specializes just in behavior and that's kind of all she does.

So that's cool. That is pretty cool. Yeah. Yeah.

I mean, honestly, if you're gonna do behavior, you better specialize in it. Better. It's, it's. It's a beast. Tough. Yeah. There really is. There's not a lot of people specialized in it. I think there was one veterinarian in Dallas that was specialized and then Pecora State. I think those are the two like in our region. Yeah. Yeah, it's the same for nutritionists. Like there's like, they said there's like a hundred veterinary nutritionists in the country.

Which actually seems like a lot to me. Because that would be like two per state, like if we were going to average it out. That's true, but they're not two per state. They're not. There's probably like 10 per state, like back east. How many cardiologists are there? I don't know. Not enough is the short answer. I wanted to know that. I know. Dr. Dame and I are going to get some like CE on Echo, and we're both like internally screaming.

But you can't refer. So you got to like. You can, but most people don't want to have a cat or a dog in the car for three hours to go to Dallas. And your wait time can be, like, you know, months. And so it's just like, we got to figure this out right now. It's expensive. Anyway, blah, blah, blah. We're froze.

Okay. So anything else we want to say about Fluted in general? I think so. Okay. I mean, I think we covered it. But, like, if you have questions, as always, we're here. Yeah. Send us an email or text if you want. Yes. And then if you have any requests for another episode topic, shoot that my way. Otherwise, we will just wait for another disease process to come in and be like, wait, I wanted to have the client listen to the podcast about that. I don't have one.

I have one. Oh, exciting. All right, cool. Well, we're going to sign off. Y'all have a great rest of your day. Music.